Will Spears

@doctorORbust This photo can only be taken with wine…🙂

Proof that I’m neurologist

@vasisht @emily_fri Our group is working on a protocol for exactly this! SBTs at 4am for everyone and discussion with RTs before am signout

@emily_fri I really want SBTs to be done overnight so patients who are ready can be extubated first thing in the morning, get seen post-extubation on rounds, and transferred out of the icu that afternoon. Challenging to do with RT shortages nationwide

The second S in FASTHUGSBID stands for one of my favorite things ever in the ICU, the SPONTANEOUS BREATHING TRIAL What pearls, pet peeves, guidelines, and resources do you have on SBTs?

@S__Baksh Seems mostly true from my experience but not as scary as they make it sound. The part about not negotiating needs with your PD is def wrong though

@DanHarrisonMD @critconcepts @PulmCrit @IM_Crit_ @emcrit @caseyalbin @DrUsaamahKhan @yasminaghajan @HeraKamdar @SWahlster @judyhtchang @patmchen @sigman_md Agree, would prob not realistically have a patient oriented outcome. I might think of an outcome like total vasopressor needed, for ex more central art line may = less norepi to meet higher MAP goal. But whether this leads to different outcomes, who knows

@critconcepts @we__spears @PulmCrit @IM_Crit_ @emcrit @caseyalbin @DrUsaamahKhan @yasminaghajan @HeraKamdar @SWahlster @judyhtchang @patmchen @sigman_md Totally agree. Measured outcome would need to be symptomatic vasospasm rather than radiographic vasospasm only (and would guess there would be no meaningful difference between peripherally and centrally monitored groups).

Do you place ulnar arterial lines? @PulmCrit @IM_Crit_ @caseyalbin @andrewyu8 @critconcepts @HeraKamdar @yasminaghajan @sigman @DrUsaamahKhan

@PulmCrit @DanHarrisonMD @IM_Crit_ @emcrit @critconcepts @caseyalbin @DrUsaamahKhan @yasminaghajan @HeraKamdar @SWahlster @judyhtchang @patmchen @sigman_md Interesting NCC study might be central vs peripheral invasive hemodynamic monitoring in aSAH?

@PulmCrit @DanHarrisonMD @IM_Crit_ @emcrit @critconcepts @caseyalbin @DrUsaamahKhan @yasminaghajan @HeraKamdar @SWahlster @judyhtchang @patmchen @sigman_md Really great article. We often have prolonged art lines for vasospasm in aSAH, frustrating to see multiple radial lines fail in some cases, and probably less accurate. Lots to consider

@Brandon_Beaber @rkchoi Depending on immune status could also consider toxo, esp with age and basal ganglia involvement

80-year old woman who developed fever and confusion, focal-onset seizure 2 weeks after after covid-19 pneumonia. THIS was found on MRI. Diagnosis? Hint: extremely rare in this age group.

@rkchoi @PulmCrit Wonder if serial ONSD would make more sense in this scenario? Already available in the ICU, probably easier for most providers

@PulmCrit Interestingly, early protocols required daily fundoscopic examinations to look for ⬆️Icp and then LP as well 😬. Can send you our protocol, if that’s helpful

writing a fresh IBCC chapter on CAR-T cell recipients in the ICU & neuroICU. what pearls & hot references should I include? 🚗

@DanHarrisonMD @PulmCrit @IM_Crit_ @caseyalbin @andrewyu8 @critconcepts @HeraKamdar @yasminaghajan @sigman @DrUsaamahKhan Interesting! Was thinking about this recently when I had a patient with small vessels and an unusually prominent ulnar

If I’ve learned anything from airway elective so far, it’s that anesthesia attendings have the jaw-thrusting finger strength of elite rock climbers..

@emily_fri Was just in this situation! Used my left hand, but felt very awkward, esp as a trainee without a ton of experience. Might try leaning over from the R next time. How does sitting on the bed help?

You stick right handed and you need to place a line in a patient’s left fem (reverse if you’re left handed). How do you do it? A. Stand on patient’s right, reach over B. Go to patients left, sit on bed C. Go to patients left (other)

Really wonderful write-up in the @nytimes today about EVT. I’ve had the privilege of seeing some incredible outcomes following thrombectomy, although more work is needed to get as many people access to treatment as possible. nytimes.com/2023/03/01/mag… @NguyenThanhMD @AbdalkaderMD

@theABofPharmaC Very cool! We have a dot phrase for shivering but this is much better, especially for consults

Shivering Control during TTM🥶 Multimodal pharmacotherapy💊may provide ⤴️ shiver control compared to a single agent alone ⚠️Despite⬆️efficacy, meperidine use has largely fallen out of favor due to toxicities What’s your preferred combo? #PharmICU #NeuroICU #CritCare

@PulmCrit Hard to take it seriously even as board review when it doesn’t even include all brainstem reflexes, no mention of prerequisites or ancillary testing to name a few…and imaging should always be done

there are a couple flecks of truth in here, but overall I find this to be superficial, glib, disrespectful to neurologists, and somewhat dangerous. for a serious discussion of how to approach brain death certification see the IBCC chapter on this. emcrit.org/ibcc/brain-dea…

@MicieliA_MD Agree with @a_charidimou, would not tPA for a rapidly improving and no disabling deficit, but extremely low threshold for MT, I find these patients often worsen and then it may be too late.

Code Stroke🧠🚑💨 Patient in 80s with untreated Afib, mRS 3 from home. Develops left hemiplegia at home lasting 10 min with significant improvement O/E: non-disabling mild left arm weakness. NIHSS 1 ASPECTS 10. CTA thick MIPS below Now 4 hrs from onset. How would you manage?

At #NCS2022… probably reflecting on how we all treat cerebral edema a little bit differently… @Char237237 & an all star, all woman group are looking to figure out HOW differently👉👉: redcap.bumc.bu.edu/surveys/?s=ARL… Pls take! @drdangayach @aartisarwal @NeurocritCareJ @neurocritical

@IM_Crit_ If I’m feeling ok during a week of night shifts, I’ll wake up in the afternoon and work out before going in. Consistency has been lacking though, and transitions back to days are hardest.

I am in a stretch of night shifts. I have tried to work out a bit when I go home post-call. Nothing too hard, just walking on the treadmill for a mile but the more I can do is to walk from shower to bed... Are you one of the superhumans that can exercise between night calls?

Me: earnestly studies for neuro boards and now realizes what all the attendings were talking about during conference.

Lessons learned from a neurologist after first month in the MICU: 1- Lots of critical care left to learn, 2- Ultrasound is super fun, 3- Running rounds is scary but necessary. Looking forward to month 2 back in NCC!

@doctorORbust I’m jittery with anticipation…

This will only have an impact with like four people, but I’m going to see “single” fiber EMG and I’m very excited 😆